POS0559 COMPLIANCE WITH RECOMMENDATIONS OF LOW INTAKE OF RED MEAT AND HIGH FIBER INTAKE IS ASSOCIATED WITH A REDUCED RISK OF RHEUMATOID ARTHRITIS
Authors: R. Bäcklund, I. Drake, E. Sonestedt, M. Compagno, U. Bergström, C. Turesson
Journal: Annals of the Rheumatic Diseases (2022)

Background Diet has received much attention as a factor that may contribute to the development of rheumatoid arthritis (RA). Several different nutrients, food components and dietary patterns have been studied in different populations. There is limited information on the importance of compliance with diet recommendations in this context. Objectives The aim of this study was to investigate the relation between overall dietary quality, diet components, and the risk of RA. Methods Participants in a population-based survey conducted in 1991-1996 who were subsequently diagnosed with RA (from inclusion until December 2004) were identified through register linkage and validated in a structured process. Four controls for each case, matched for sex, year of birth, and year of inclusion, were selected from the study cohort. The controls were alive and RA-free when the index person was diagnosed with RA. At inclusion, diet was assessed using a modified diet history method, consisting of a seven-day food record, a food questionnaire, and a supplementary interview. The New Diet Score (NDS) reflects the recommendations in the Swedish dietary guidelines (SDG) from 2015, produced developed by the Swedish Food Agency, which in turn are based on the Nordic Nutrition Recommendations from 2012. According to the SDG, it is recommended to eat more fiber, vegetables and fruits and fish, and less red meat and added sugars. The mentioned dietary components are all included in the NDS, with a range 0-5. A score of 1 was assigned to each component where the individual complied with the recommendation. Non-compliance was assigned a score of 0. The cutoff values for the recommendations are based on a previously validated Diet Quality Index, except for red meat (based on SDG) and added sugars (based on World Health Organization guidelines from 2015 for sugar intake). We used conditional logistic regression analysis to study the relation between NDS, its components, and RA. The NDS was divided into categories, defined as low (0–1), moderate (2–3) and high (4-5), with “low” as reference, and also assessed as a continuous variable. All models were adjusted for reported total energy intake, and potential misreporters of total energy intake were excluded. We designed multivariable-adjusted models in which we included covariates that had been associated with diet and RA (smoking, alcohol and leisure time physical activity). Results In the study population, 172 RA cases were identified. Low red meat intake (&lt;500 g/week) was significantly associated with a decreased risk of RA (Table 1). Compliance with the recommendations for intake of fiber and vegetables and fruit were inversely associated with RA, with a similar trend for the total NDS (Table). In additional multivariable analysis, including both variables and relevant confounders, compliance with recommendations for red meat intake (odds ratio (OR) 0.43; 95% CI 0.22-0.85) and for fiber intake (OR 0.53; 95% CI 0.30-0.94) were both associated with a reduced risk of RA. Table 1. Multivariable-adjusted odds ratios (ORs) describing the relation between New Diet Score (NDS) and its components and the risk of developing rheumatoid arthritis Adjusted for reported energy intake, smoking, alcohol, leisure time physical activity NDS components Recommendation OR 95% CI Fibre ≥2.4 g/MJ 0.51 0.29–0.90 Vegetables and fruits ≥400 g/day 0.55 0.32–0.95 Fish ≥300 g/week 1.25 0.76–2.05 Added sugar ≤10 E% 1.10 0.68–1.78 Red meat &lt;500 g/week 0.42 0.22–0.81 NDS 0–1 1.00 (Ref ) 2–3 0.65 0.38–1.10 4–5 0.67 0.30–1.46 Per point increment 0.82 0.67–1.00 Conclusion These preliminary results indicate that low intake of red meat and higher fiber intake, in line with current recommendations, are independently associated with reduced risk of developing RA, suggesting that components found in meat and fiber-rich foods may affect very early disease mechanisms. Disclosure of Interests None declared.